Provider Demographics
NPI:1689019036
Name:LOPEZ, STEPHANIE M (MS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12302 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-9734
Mailing Address - Country:US
Mailing Address - Phone:928-669-5243
Mailing Address - Fax:928-669-5549
Practice Address - Street 1:12302 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-9734
Practice Address - Country:US
Practice Address - Phone:928-669-5243
Practice Address - Fax:928-669-5549
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)